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This dissertation reports on an investigation into relationships between human embryo, oocyte and follicular features and the developmental potential of the associated IVF embryos on transfer. An improved understanding could yield insights into biological factors influencing the development process. Besides, identifying the features associated with a good developmental potential could assist embryologists in an informed selection of the 'best' embryos for transfer. Previous studies with the same broad goal have suffered from a number of limitations. The present study attempts to overcome some of these by using the technique of 'decision tree' analysis developed in Machine Learning in Computer Science. The technique analyses data related to a sufficient number of specific examples in a group and discovers the general combinations of features characterising the group, presenting results in an easily comprehensible form. The feasibility of using the technique was first explored in a pilot study. The patterns of features characterising the 'good' embryos that resulted in triplet pregnancies on 3 embryo transfer or high hCG secretion in vitro and the 'bad' embryos that did not progress to the blastocyst stage on in vitro culture were identified. Given the promising nature of the results, a larger study, which forms the core of the dissertation, was conducted. Data included 53 features relating to the follicle, oocyte and embryo for batches of 3 embryos transferred that resulted in either a Take home baby (TH) outcome or a negative pregnancy test (NTH). The relationship between the 53 features and the 'TH' or 'NTH' developmental potential was investigated. The results identify, amongst others, two features related to the follicular stage of development as being important determinants of the TH potential, thereby confirming that developmental potential of an embryo is determined as early as the stage of the unfertilised oocyte. The embryo grading used by embryologists in the Oxford IVF Unit was identified as important, providing for the first time an unbiased corroboration of the selection process used in the Unit. The results refine the selection criteria and suggest two additional features, namely, follicular fluid volume and rate of cleavage as being worthy of further investigation, with the latter feature being indicated as the main component of the embryo grade characterising batches that resulted in a TH outcome. The relative unimportance of a number of features recorded in the patient notes but showing no relationship to development too is identified. The method of analysis used here could have wide-ranging applicability to a number of areas within IVF. A demonstration of this is provided in this dissertation in an area of growing importance, namely, the identification of blastocysts of different quality. The main study reported here can be extended to incorporate maternal and sperm features. Results obtained could form the basis for assisting embryologists in the selection of embryos with the 'best' developmental potential, with the possibility of an increase in IVF success rates.

published_or_final_version / abstract / Obstetrics and Gynaecology / Master / Master of Philosophy

This thesis explores the processual nature of agency and constraints in the experience of medicalized conception in a not yet explored locale: Bogota, Colombia. In ten months of ethnographic research at two fertility centers in Bogota, and interview data from over 100 in-depth interviews with women and men undergoing ARTs and clinic staff, a complex ART industry driven by both doctors (qua entrepreneurs) and the couples seeking medicalized conception was explored. This thesis identifies how relationships in the clinic combined with understandings of “the fragmented body” (as a medicalized object under scrutiny) and “the self” (as a conscious agent), to produce intricate dynamics of agency and constraints that co-evolved in a processual manner. Tracing the experiences of women in infertility treatment chronologically, the thesis explores how knowledge was established and renegotiated through productive power fields that relationally incorporated embodied, personal knowledge and authoritative medical expertise. Women adapted to constraints in both active and passive ways to create and assert their ever-transforming agentive capacities. In these processes, they were constantly reflecting on, and renegotiating their position in the treatment process, as well as in their social lives more broadly. Drawing on, and seeking to contribute to, literature on agency in ARTs from across the world, particularly literature that considers agency as a process co-established by the constraints it confronts, this thesis makes two key arguments: First, that agency in Colombian ART clinics is defined as reflection and renegotiation, rather than as something which occurs at a singular moment of reflection and renegotiation. Second, that this negotiated process is constrained, but not contained. In other words, agency is a process that looks both backwards and forwards. Women and couples incorporated different personal histories and embodied knowledge into negotiating the treatment process and constraints they encountered, and adapted their experiences of ART treatments to other aspects of their lives, negotiating constraints that reach beyond the clinical setting.

Bakgrund: Ofrivillig barnlöshet är ett vanligt problem hos par i fertil ålder och drabbar runt 15–20 % av alla par i västvärlden som önskar få barn. Infertilitet och infertilitetsvård kan bidra till sämre hälsa och kan vara påfrestande för båda parter i paret. Processen kan även leda till ett lidande där sjuksköterskan har en viktig roll. För att bemöta par och tillgodose deras önskemål är det angeläget att studera vilka behov de upplever. Syfte: Att beskriva behov par erfar i samband med infertilitetsvård. Metod: En litteraturöversikt där datamaterial bestod av sju vetenskapliga artiklar varav två kvantitativa, fyra kvalitativa och en av mixad metod. Resultat: I resultatet framkom tre teman, Stöd, Respekt och förståelse samt En utformad och anpassad miljö. Det framkom även sex subteman. Konklusion: Att möta par inom infertilitetsvård kan vara komplext och ytterligare kunskap kring vilka behov de upplever kan vara angeläget. Som sjuksköterska är det viktigt att bidra med stöd och information gällande processen. Det är även viktigt att individualisera vården och se till varje pars egna önskemål. Respekt och förståelse samt anpassning och utveckling av organisationen är angeläget där högre instanser bör bli engagerade. / Background: Involuntary infertility is a common problem in couples of fertile age and affects around 15–20% of all couples in the Western world who wish to have children. Infertility and the care can contribute to poorer health, which can be stressful for both parties in the couple. The process can also lead to a suffering were the nurse has an important role to play. To respond to the couple and meet their wishes, it is important to study the needs they experiences. Aim: To describe the needs couple experiences in connection with infertility care. Method: A literature review where data material consisted of seven scientific articles, two of which were quantitative, four qualitative and one of mixed method. Results: From the result, three themes appeared, Support, Respect and understanding and An Adapted and developed environment. There were also six sub-themes. Conclusion: Meeting couples in infertility care can be complex and further knowledge about what needs they are experiencing can be important. As a nurse, it is important to contribute with support and information regarding the process. It is also important to individualize the care and look to each couple's own wishes. Respect and understanding as well as adaptation and development of the organization are urgent where higher instances should become involved.

The experience of difficulties in conception, the diagnosis of infertility and its treatment are frequently associated with anxiety and overall distress. However, current understanding regarding the determinants of variability in the levels of distress among women undergoing infertility treatment is limited; and the evidence of the significance of distress as a risk factor for assisted conception following IVF/ICSI is inconsistent. The thesis addressed both these issues. Overall the thesis is informed by the biopsychosocial model of health and illness. Four studies were conducted. The data was collected in three IVF clinics in India. A consecutive sample of 85 infertile women about to commence IVF/ICSI cycle was recruited in the project at cycle baseline and followed through one treatment cycle. The first two studies examined this sample of women at baseline to identify the biopsychosocial factors associated with infertility related distress. The first study examined the degree of cognitive–behavioural adjustment to infertility, its treatment and treatment related eventualities, while the second study focused on the factors associated with affective aspects of infertility related distress such as increase in negativity and decrease in positivity. The third study examined the pattern of change in stress operationalized in terms of changes in Affect and State Anxiety in a sample of 74 infertile women during an IVF/ICSI cycle. The final study developed a prognostic model for evaluating the unique contribution of baseline distress as well as treatment related stress in estimating the odds of pregnancy following IVF based on a consecutive sample of 73 women. Collectively, the first two studies indicate that at the outset of the IVF/ICSI cycle, some women are more prone to distress than others, and that this variability is associated with their intrapersonal, interpersonal and sociodemographic attributes. These two studies have identified a set of protective and vulnerability factors related to cognitive-behavioural and affective aspects of distress. The last two studies clearly indicate that the level of distress tends to rise during the treatment among the majority of infertile women. The rising trend continued to be significant even after controlling for variables known to somewhat influence infertility related distress such as age, education, occupation, employment, financial burden and etiological factors. Further, a prognostic model is developed that proposes that both baseline level of stress and treatment stress make a unique contribution in defining the odds of pregnancy outcome for the patients. In short the thesis clearly brings out the case for integrating psychosocial care with the routine medical interventions for infertility. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1325419 / Thesis (Ph.D.) - University of Adelaide, School of Psychology, 2008

<p>Syftet med denna studie var att undersöka vikten av ett genetiskt föräldraskap hos par som genomgick infertilitetsbehandling i Sverige med donerade ägg eller spermier, samt att jämföra attityder till genetiskt föräldraskap mellan kvinnor och män samt personer med eller utan möjlighet till genetiskt föräldraskap. Denna delstudie ingår i ett större projekt som heter Långtidsuppföljning av IVF, ägg- och spermiedonation i Sverige. Den grupp som har undersökts i föreliggande studie är par som genomgått behandling med donerade ägg eller spermier under 2005-2006. Antalet recipienter i denna studie var 277 personer. Information har samlats in i form av enkäter. Resultatet visade tydligt att nästan alla deltagare instämmer i att föräldrar är de som lever med och tar hand om ett barn oavsett genetiskt släktskap. Resultatet visade inga signifikanta skillnader i attityder till genetiskt föräldraskap oavsett om deltagarna hade möjlighet till genetiskt föräldraskap eller inte.</p> / <p>The aim with this study was to find out how important it is with genetic parenthood for couples undergoing infertility treatment in Sweden with donated eggs or sperms, and to compare attitudes to genetic parenthood between women and men and between persons with or without possibility to genetic parenthood. The present study is included in a larger project called Long-term follow-up of IVF, oocyte - and sperm donation in Sweden. The group that has been examined in the present study are couples who underwent infertility treatment with donated eggs or sperms during 2005-2006. A total of 277 persons participated in the study. Information has been gathered with questionnaires. The results clearly showed that almost all participants agree that parents are those who live with and take care of a child independent of genetic relationship. The result did not show any significant differences in attitudes to genetic parenthood irrespective of whether the participants had possibility to genetic parenthood or not.</p>

Syftet med denna studie var att undersöka vikten av ett genetiskt föräldraskap hos par som genomgick infertilitetsbehandling i Sverige med donerade ägg eller spermier, samt att jämföra attityder till genetiskt föräldraskap mellan kvinnor och män samt personer med eller utan möjlighet till genetiskt föräldraskap. Denna delstudie ingår i ett större projekt som heter Långtidsuppföljning av IVF, ägg- och spermiedonation i Sverige. Den grupp som har undersökts i föreliggande studie är par som genomgått behandling med donerade ägg eller spermier under 2005-2006. Antalet recipienter i denna studie var 277 personer. Information har samlats in i form av enkäter. Resultatet visade tydligt att nästan alla deltagare instämmer i att föräldrar är de som lever med och tar hand om ett barn oavsett genetiskt släktskap. Resultatet visade inga signifikanta skillnader i attityder till genetiskt föräldraskap oavsett om deltagarna hade möjlighet till genetiskt föräldraskap eller inte. / The aim with this study was to find out how important it is with genetic parenthood for couples undergoing infertility treatment in Sweden with donated eggs or sperms, and to compare attitudes to genetic parenthood between women and men and between persons with or without possibility to genetic parenthood. The present study is included in a larger project called Long-term follow-up of IVF, oocyte - and sperm donation in Sweden. The group that has been examined in the present study are couples who underwent infertility treatment with donated eggs or sperms during 2005-2006. A total of 277 persons participated in the study. Information has been gathered with questionnaires. The results clearly showed that almost all participants agree that parents are those who live with and take care of a child independent of genetic relationship. The result did not show any significant differences in attitudes to genetic parenthood irrespective of whether the participants had possibility to genetic parenthood or not.

The experience of difficulties in conception, the diagnosis of infertility and its treatment are frequently associated with anxiety and overall distress. However, current understanding regarding the determinants of variability in the levels of distress among women undergoing infertility treatment is limited; and the evidence of the significance of distress as a risk factor for assisted conception following IVF/ICSI is inconsistent. The thesis addressed both these issues. Overall the thesis is informed by the biopsychosocial model of health and illness. Four studies were conducted. The data was collected in three IVF clinics in India. A consecutive sample of 85 infertile women about to commence IVF/ICSI cycle was recruited in the project at cycle baseline and followed through one treatment cycle. The first two studies examined this sample of women at baseline to identify the biopsychosocial factors associated with infertility related distress. The first study examined the degree of cognitive–behavioural adjustment to infertility, its treatment and treatment related eventualities, while the second study focused on the factors associated with affective aspects of infertility related distress such as increase in negativity and decrease in positivity. The third study examined the pattern of change in stress operationalized in terms of changes in Affect and State Anxiety in a sample of 74 infertile women during an IVF/ICSI cycle. The final study developed a prognostic model for evaluating the unique contribution of baseline distress as well as treatment related stress in estimating the odds of pregnancy following IVF based on a consecutive sample of 73 women. Collectively, the first two studies indicate that at the outset of the IVF/ICSI cycle, some women are more prone to distress than others, and that this variability is associated with their intrapersonal, interpersonal and sociodemographic attributes. These two studies have identified a set of protective and vulnerability factors related to cognitive-behavioural and affective aspects of distress. The last two studies clearly indicate that the level of distress tends to rise during the treatment among the majority of infertile women. The rising trend continued to be significant even after controlling for variables known to somewhat influence infertility related distress such as age, education, occupation, employment, financial burden and etiological factors. Further, a prognostic model is developed that proposes that both baseline level of stress and treatment stress make a unique contribution in defining the odds of pregnancy outcome for the patients. In short the thesis clearly brings out the case for integrating psychosocial care with the routine medical interventions for infertility. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1325419 / Thesis (Ph.D.) - University of Adelaide, School of Psychology, 2008